Jerry Cowley (Mayo, Independent)

My problem with the amendment is that its statement of strategy, detailing plans for funding the care of the elderly in both public and private nursing homes, omits care in the community and in a person's own home. Elderly people want to continue living in their own homes. Who wants to spend his or her life in a community only to have to go in retirement to a far away place where he or she knows no one and, like the old Indian, loses heart and dies? I have seen too many elderly people having to leave their communities and homes because no one can look after them. The most vulnerable in our communities who deserve support and care are those older persons who must leave them. The migration of older people into institutions is both sad and silent. Sad because it need not happen; silent because no one discusses it.

The amendment should include the giving of support to older people at home. Instead, it only concentrates on public and private nursing homes. I accept these are only available in the absence of a community alternative. People in nursing homes do good work. However, it is more important that support is given to those elderly people who want to remain in their own communities. Any strategy that does not address the need to support older people in their own communities is deficient in providing the means to allow them to stay at home. So many policy statements have been written with lip service paid to this concept. The Years Ahead, a wonderful review, found no progress had been made on the issue.

Support for the elderly in the community has no statutory basis. Funding has not been made available. What funding is available for the 5% of the older persons' population maintained in nursing homes is begrudged to it. Why should this be if it only affects 5% of the elderly population? This is the group that by definition cannot look after itself and needs total nursing care. We need to reflect seriously on what we are saying and doing. Institutionalisation is not the right direction to take. The health strategy refers to consultation, eligibility and entitlement, nursing home subvention scheme improvements and other important matters that need to be addressed. Again, lip service when an adequate response is needed.

A means by which older people can be maintained in their communities, particularly in their own homes, must be introduced. The difficulty has been that some older people have had to go nursing homes because they did not receive a home help service. If they had, they could have been sustained for longer in their homes. Older people must be assessed quickly for grants to ensure repairs to their houses are completed in a short period. However, they could be dead and buried by the time their houses are assessed. Supports such as physiotherapy and speech therapy for those who have suffered strokes are not available. Is it any wonder people end up in institutions?

The emphasis must be on maintaining the individual in his or her home for as long as possible. Where that is not possible, the next best stage is care in the community. There are communities prepared to support older people and which have the potential to do so but it is not being realised. Sheltered housing is the next best option for an individual who cannot be maintained in his or her own home. The difficulty is that the Government's targets for sheltered housing are not being honoured due to the lack of necessary funding and planning problems.

Some communities have been proactive in supporting older people in sheltered housing. However, when an older person needs more support, there is often nothing for him or her but institutionalisation. The community which has saved the older person from a far away institution ends up hanging its head in shame as the older person is forced into a profit driven, non-community nursing home, mainly provided by the private sector.

The alternative is for communities to supply the high support needed by the individual who has the continuum of care and support to which health policy documents constantly refer. The continuum extends from support at home to low and then high support sheltered housing, guaranteeing no matter how old or disabled the person is, he or she can be maintained in the community. This happens in the St. Brendan's village scheme. However, it is not, particularly the high support end, being replicated elsewhere because of inadequate funding. If communities are to achieve similar schemes, legislative changes must be made. For people to be supported in low support housing, there is a need for a defined revenue scheme. However, it is not in place; instead there is a penny wise and pound foolish approach. The introduction of such a scheme would allow those communities which build and manage sheltered houses to employ the staff needed to support those elderly persons who become more disabled in time. When a person needs a higher degree of support, instead of going to a far away institution, he or she moves sideways into a high support unit within the community. However, for this to happen, a capital funding provision must be in place. It is available for profit driven, non-community nursing homes. Why should it not be available for communities to do this? It is wrong that it is not because communities do not want to lose their older people. It could be done quite easily if funding was made available. For instance, it could be done under the capital assistance scheme but there are rules stating it should not be done. If it is done, it should be possible for a community to be able to register because under the law, it is obliged to register if looking after disabled people. There should be a provision to enable communities to build under the capital assistance scheme and register under the Nursing Homes Acts. That would ensure the standards needed. Standards are not being tested in State institutions, which an inspectorate would ensure.

People talk about the problem of older people; it is not a problem but a challenge. Older people should not be segregated. We are all getting older and older people need to be included in society and not excluded. The way forward is to support older people at home, if at all possible. To do that, funding is need which has never been properly provided. If a person can no longer be supported in their own home, low support and high support sheltered housing should be provided. In that way, there is a guarantee that no matter how old or disabled the person, he or she can be maintained in his or her community. I have yet to meet anyone who wants to leave his or her own community.

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